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A Focus on Obesity, Part 2:
••Summer 2003/Vol. 7, No. 3

Comments from the Journal EditorsAbstracts from articles published in other journals
CommentaryClinical articles on the practice of Permanente medicine
Poetry, Art, Musings from Permanente clinicians
Articles from a Systems perspective
Nonclinical articles on external issues
Book Reviews

 

 

 

 

 

 

 

 

 


Soul of the Healer



Anorexia: The Scream on the Other Side of Silence | pdf >>
Anonymous

Why would one ever include autobiographical material about anorexia nervosa with articles on obesity? Many will be surprised that identical thought processes are often present in both: "Eating is the only thing left in my life that I can control."

Anorexia nervosa is still a condition of mystery and threat. Fifty years ago, serious physicians felt it was some yet-undetermined type of primary pituitary disorder. Now, physicians accept it as some yet-undetermined type of emotional disorder. Here we have the privilege and unusual opportunity to hear a woman describe her own thought processes--the method in her madness--during the course of several anorexic years. Surprisingly, most anorexic patients pass unnoticed through the offices of their physicians. We don't go out of our way to recognize that which we do not understand. And yet one wonders, disturbingly, how many patients might explain their problems clearly if we asked and listened? -- Vincent J Felitti, MD, Editor

I invite you to starve with me. You will not like it at first, but ask yourself this: Did you like the first cigarette you smoked? The first whiskey that burned your throat? The first "one-night stand"? Each of those "fixes" helped you in some way, didn't it? It gave you the power to feel better--at least for a moment.

If you will join me, you will learn just how empowering starvation can be. You will be in complete control of yourself and of the people around you. How many people can say that and know that it is true?

Be me. A 13-year-old girl, 5'6" tall, about 120 lbs. Your mother is long since dead. Your father doesn't want you to live with him. You are now serving your sixth year of what feels like a life sentence with his sister and her husband. Your aunt--"She"--sees everything about you as a reflection of herself. If your hair does not curl, there is not enough starch in your blouse, your tummy is not flat enough, your breasts not large enough, your shoes not polished enough, your smile not cheerful enough, then the neighbors will think She is not doing a good job. She makes you spend hours cleaning, ironing, weeding, and such; She even lines up paying jobs--and yet you must get As--That is important. It is a reflection on Her.

You like school. You love to learn. Every new thought inspires you. You are one of the brightest, most industrious, most compliant, and still popular girls in your class, yet She calls you "a goddam intellectual" when She is angry with you--and She is often angry. Nothing you do will ever be enough. You know it. Every mirror you look into reflects a person who will never be what She is supposed to be, no matter how hard She tries.

You cannot hide from the mirrors. They own you. Your aunt owns you. You will never be free. There is no escape ... or is there?

You begin to cut back on the already-meager portions She gives you. Did She notice? You think She did, but She hasn't said anything about it. Cut back more. What does the mirror say? Hmmm, still fat. Cut back more. A week goes by, a month, and now you are eating almost nothing, three or four bites of food a day, maybe a soft drink once in a while. Sometimes you cheat and eat the apple from your lunch before you throw it into the trash bin. You are SO HUNGRY ... ravenous, and yet you watch that brown paper sack leave your hand in freeze-frame slow motion, hear it THUD at the bottom of the bin, knowing its contents would stop the hunger. You will not eat. If you eat, you lose.

You're tired all the time now, but look! Your clothes fit loosely--finally! Progress.

Your hunger is ravaging. You think of food all the time. The world takes on a clarity that you have never before noticed. You see every detail of every single thing. Sounds are louder, smells stronger. Another month goes by. You've lost 20 lbs. She notices! "Why aren't you eating? Are you sick?"

Oh yes, you're sick, but it is not the kind of sick that anyone can fix. You are on a mission to ensure that they cannot. You cannot let them get that close to you. If they do, they will hurt you. Oh yes, with hunger also comes fear--fear of absolutely everything. You're skittish. You jump at the slightest sound. You're wakeful, staring at the ceiling through the night. When you finally sleep, nightmares shatter your rest. There is no peace, but it is the price you pay for screaming the silent scream of starvation--the price you pay for power.

And it is worth the pricetag. She is now very disturbed by your weight loss--but not for the right reasons. Not because She loves you. Does anyone love you? She rages, "I spent hours sewing that for you, and now it doesn't fit you anymore!" VICTORY! Even your father notices. "Look at those arms! You'd better start eating. You look like a skeleton."

All you think about is food--the sight, the smell, what it used to taste like. It doesn't taste like anything anymore. Nothing tastes good to you. You've learned to replace hunger by imagining you've eaten. You feel the texture of mashed potatoes, sticking to the roof of your mouth. Your mental acuity seems to have sharpened--yet you have difficulty remembering. It is easy to slip into a trancelike state where you create your own reality--one in which She has no place.

In just a few months, you have mastered a most basic need: To eat. You are in control of your most essential self. In very little time, you have brought Her to her knees. She now begs you--begs you--to eat. She'll do anything to make you eat. You have total power. You have won.

You're almost 14 years old now and not a bad kid. You didn't really want to upset anyone--much--you just wanted to make it clear that you are upset. Had you said that, She'd have slapped you across the face, pulled your hair, given you a week of The Silent Treatment, and still more chores. Words failed you, so you drew them a picture: a stick figure of you.

Have they learned their lesson? Should you let them off the hook? Or should you make them really suffer, really sorry? Should you stop eating completely? You know what that means. You'll die. Should you die?

You're not a bad kid--not a stupid kid. Isn't this taking it a little too far? Okay, you caught the firefly--do you really need to kill it too? No, let the anger go. Forgive them. Forgive yourself for being so angry with them. Let yourself live. Let them have the power back again. You held it for a while--a long and painful while. Now you know you're stronger than they are. You know you can have the power back whenever you want it.

They were never trying to hurt you in the first place.

 

According to the National Institute of Mental Health, "Females are much more likely than males to develop an eating disorder ... an estimated 0.5% to 3.7% of females suffer from anorexia and an estimated 1.1% to 4.2% suffer from bulimia ... The mortality rate among people with anorexia has been estimated at 0.56% per year, or approximately 5.6% per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15 to 24 in the general population.1

 

 

Reference

  1. National Institute of Mental Health. The numbers count: mental disorders in America [Web page]. Available from: www.nimh.nih.gov/publicat/numbers.cfm (accessed July 22, 2003).

 

 

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